Cancer and its treatment are associated with numerous consequential physical and psychological symptoms and adverse effects at the active treatment, survivorship, and end-of-life stages. Oncology nurses play a critical role in assisting cancer patients at different disease stages with managing symptoms and improving quality of life. Physical activity is a potentially effective intervention for promoting health and alleviating physical and psychological symptoms associated with cancer and its treatment. Regular physical activity may provide many health benefits for cancer patients including improving quality of life and cardiopulmonary function and diminishing fatigue.1–3 The effects of physical activity on cancer during and after medical treatment have been examined in several meta-analyses, with most of them focusing on early-stage breast cancer or colorectal cancer. A recent meta-analysis4 showed that physical activity has positive effects on physiology, body composition, physical functions, psychological outcomes, and quality of life in patients after treatment for breast cancer. When patients with cancers other than breast cancer were included, physical activity was associated with reduced body mass index and body weight, increased peak oxygen consumption and peak power output, and improved quality of life.4
In a series of studies by our research group on physical activity intervention in lung cancer patients, we determined that 85.2% of the participants preferred to receive physical-activity counseling during their cancer experience.5 Walking was the most preferred form of exercise.5 Exercise adherence is a challenge for lung cancer patients. Participants with higher social support and self-efficacy are more likely to initiate physical activity and participate in a moderate- to vigorous-intensity physical activity program.5 Social support and self-efficacy are the main factors required for maintaining walking exercise for 6 months.6 Moreover, in a randomized controlled trial, lung cancer patients in an exercise group exhibited significantly greater improvements in their anxiety and depression levels in the third and sixth months than did patients in the usual-care group.7 Overall then, the benefit of exercise and physical activity for patients in curative cancer treatment is fairly well established. The benefit during end of life is not yet established.
The goals of end-of-life care are to relieve symptoms and to improve quality of life. A decline in physical function, resulting in loss of mobility and independence, has been identified as 1 of the most distressing symptoms negatively affecting quality of life in cancer patients receiving end-of-life care. A systematic review of physical activity in cancer patients receiving palliative care8 showed that none of the patients reported engaging in physical activity with moderate intensity (ie, brisk walking) or strenuous exercise (ie, running, aerobics classes, cross-country skiing, vigorous swimming, or vigorous cycling). Walking was the most commonly reported physical activity among the patients. A significantly slower rate of decline in total well-being, as well as a significantly slower rate of increase in total fatigue, was observed. In addition, they discovered a trend of improvement in patient-reported quality of life, fatigue, and physical functioning after the exercise intervention. Most importantly, the patients were able to complete physical-activity interventions, with some of the patients reporting improvements. Some of the patients were willing and able to tolerate physical-activity interventions, with some patients demonstrating improvements in some exercises.
In conclusion, there is insufficient evidence to evaluate the effectiveness of physical activity in cancer patients receiving end-of-life care; however, a potential role for physical activity as a supportive care intervention seems promising. Nevertheless, physical activity preference, social support, and self-efficacy must be considered when implementing a physical-activity program for cancer patients receiving end-of-life care.
Chia-Chin Lin, PhD, RN
School of Nursing
College of Nursing, Taipei Medical University
Taipei, Taiwan, Republic of China
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